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Patients with ‘complex’ health issues being referred for social prescribing

Patients with ‘complex’ health issues being referred for social prescribing

Patients referred for social prescribing initiatives often have health problems that are too severe to be suitable for the services, a Government report has warned.

The report into the provision of ‘green’ social prescribing provision in England found a ‘worrying pattern of link workers and green activity providers receiving patients with complex health conditions that they are not equipped to work with’.

The review, carried out to evaluate existing provision and guide wider national roll out, also found provision to be patchy with considerable variation in the types of activities offered, availability of accessible green space and number of providers even between neighbouring PCNs.

For people with moderate to severe mental health conditions, there is a lack of specialist support available to access green social prescribing schemes which can ‘place unfair demands’ on providers and is also ‘unfair and risky’ for the individuals referred to them.

Rather than green social prescribing being integrated into the NHS in England in a way that enhances overall care, ‘there is a danger it instead acts as a holding system for service users who require more specialised support’, the report said.

Improving awareness within the health sector of the levels of need that social prescribing caters for, while increasing the availability of more specialised support services, would help to reduce numbers of inappropriate referrals, it added.

There has been a surge of interest and investment in green social prescribing in England, particularly after the Covid-19 pandemic, the review said.

An analysis of current provision and referral found most link workers mainly refer to sports and exercise schemes despite a wide range of ‘nature-based’ activities available.

And most green social prescribing schemes have the capacity to support many more individuals than they do, with often many more providers operating in an area than are currently being referred to by link workers.

In addition, referral pathways in practice do not seem to align with how they are meant to work in theory, with people often self-referring.

One respondent to the review said: ‘When I’ve met with providers and social prescribers, the referral pathways don’t seem to be there at all. It’s very rare where I’ve actually seen examples of social prescribing happening in the way it’s meant to.’

There is also an issue with the sporadic and unpredictable nature of funding for those trying to provide green activities.

And the heavy workload of many link workers means they have little capacity to establish links with different green and nature-based activity providers in their area.

For some areas there is simply not enough accessible green space and there is also a challenge in a ‘lack of interest in green and nature-based activities’ for those who would potentially benefit.

To improve capacity system wide changes are needed in funding, increased awareness of the benefits of green and nature-based systems among GPs, link workers and service users, consistency and better collaboration, it concluded.

Last year, a major review found no consistent evidence that social prescribing improves social support or physical function, or reduces the use of primary care services.

It also found only limited evidence that social prescribing improves subjective assessment of personal health or quality of care received. 


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Please note, only GPs are permitted to add comments to articles

David Church 6 April, 2023 10:43 am

But we don’t refer them for managemenet of complex medical problems, we only refer them for the tea and chats, don’t we?

Emily Parsonage 7 April, 2023 7:06 am

I agree with David
We aren’t asking them to deal with the health issues
Of course the patients with more complex health issues will be the patients who need social prescribing more!